How to improve gait and balance function in elderly individuals-compliance with principles of training

Most balance training regimens for elderly individuals focus on self-controlled exercises, although automatic postural responses after a balance perturbation are not under direct volitional control. We critically review the literature on this topic, and notice that several studies fail to comply with basic principles of training and therefore show little improvement in function. Some present the view that physical function in the too frail and too fit cannot be improved, which we instead argue would be the effect of nonspecific training programs. We propose a concept for balance training that incorporates voluntary exercises as well as perturbation and dual-task exercises to improve balance control. The program is performed on five different levels where levels 1-4 exercises focus on the skill to maintain balance and level 5 adds perturbation exercises that focus on the skill to recover balance as well as dual task exercises providing a cognitive load during execution of a balance motor task. Functional requirements for muscle strength and power are directly incorporated into the program. The feasibility of the concept has been demonstrated on elderly fallers. A randomized control trial is underway to investigate the effects on healthy elderly individuals. Further intervention studies using this concept are encouraged.